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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005211
Report Date: 08/24/2022
Date Signed: 08/24/2022 01:08:12 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/24/2022 01:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:ARDENT CAREFACILITY NUMBER:
306005211
ADMINISTRATOR:MELINDA FLORESFACILITY TYPE:
740
ADDRESS:1665 SOUTH BROOKHURST STREETTELEPHONE:
(714) 991-0991
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:27CENSUS: 22DATE:
08/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Alex Blancarte, CaregiverTIME COMPLETED:
01:22 PM
NARRATIVE
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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA Rosie Quiroz was greeted, COVID-19 screened, granted entry and met with Caregiver Alex Blancarte. LPA Quiroz called and spoke to Administrator (AD) Melinda Flores and explained the nature of the visit. AD Flores indicated she could not be present due to personal commitments and indicated Caregiver Blancarte would be available to assist LPA Quiroz with today's Annual Inspection visit. Caregiver Blancarte confirmed there are currently no cases or exposures of COVID-19 within the facility at this time. (AD) Melinda Flores has an Administrator Certificate with expiration date of 1/8/2019. LPA Quiroz inquired about Administrator certificate renewal, (AD) Melinda Flores indicated "I can't afford the extra $400 late renewal fee so haven't renewed it." LPA Quiroz provided consultation on California Code of Regulations Administrator Certification Requirements 87406. (See LIC 809-D)
On or about 11:50am, LPA Quiroz along with Caregiver Blancarte conducted inspection tour of interior and exterior of the facility. Today's observations were pertaining to the facility's Infection Control measures. There is a sign-in procedure in place and hand sanitizer for use. LPA Quiroz observed that all staff were wearing face masks. The facility has an approved Mitigation Plan on file with CCLD.
The facility is licensed to provide services to age range 60 and over, 27 Ambulatory residents of which 21 may be Non Ambulatory and 6 bedridden and has an approved hospice waiver for 6 residents.
There are 21 residents present during this visit and 1 resident at the hospital. Five of 22 residents are receiving Hospice Services and there are currently 2 bedridden residents. LPA toured all resident rooms, all rooms were within regulations. During today's visit, Residents appeared clean and content. Resident were observed to be in activity area with staff supervision, in their bedroom and living room area. On or about 12:00pm, LPA Quiroz observed staff assisting residents to the dining area to eat lunch which consisted of: Salsbury steak, corn, mashed potatoes, peach tea and water. Caregiver Blancarte indicated "Most of the residents get full and don't eat their desert during meals so we hold it for snack time so they can enjoy it."
CONTINUED ON NEXT PAGE...
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ARDENT CARE
FACILITY NUMBER: 306005211
VISIT DATE: 08/24/2022
NARRATIVE
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Restrooms observed contained soap, toilet paper and paper towels and had the proper hand washing signs posted. Facility has operating smoke and carbon monoxide detectors. Facility has Fire Extinguishers which were charged. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available in shed stored in back parking lot area of the facility. The facility monitors the residents regularly for any COVID-19 symptoms/change of condition and documents. Facility has required Emergency Disaster Plan posted, and a secured location for resident's medication and files. Facility has 30 days supply of medications for the residents. Residents emergency contact information and Physicians reports are current.

Based on observations made during today’s inspection, facility is being cited per Title 22, Division 6, of the California Code of Regulations.

LPA Quiroz reviewed this report with Caregiver Alex Blancarte and Administrator Melinda Flores via telephone and a copy of today's report , LIC 811-Confidential Names and Appeal Rights were provided at exit .
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/24/2022 01:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868


FACILITY NAME: ARDENT CARE
FACILITY NUMBER: 306005211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2022
Section Cited

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Administrator Certfication Requirements: 87406 (g)
(g) Certificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements. This requirement was not met as evidenced by...
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Based on interview and review of Administrator Certificate for Administrator Melinda Flores, certificate #6033680740 expired on 1/8/2019. AD Flores verfied via telephone at 12:06pm indicating "I can't afford the $400 late renewal fee so haven't renewed it." This poses an immediate risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
LIC809 (FAS) - (06/04)
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